More Family Doctors Are Needed, Group Says : Medicine: Physicians say lopsided ratio of specialists to generalists has driven up San Diego health care costs.

The number of family doctors in San Diego is far below the state standard, helping to make medical care too expensive for hundreds of thousands of people in the county, health experts said Friday.

The city’s lack of general practitioners trained in family medicine mirrors a problem nationwide, according to American Academy of Family Physicians members meeting this week in San Diego.

Academy doctors said the lopsided ratio of specialists to generalists has driven up the cost of basic health care.

Studies have shown that family physicians can provide the most cost-effective treatment for common illnesses--up to 90% of patient calls. However, the current medical care system in the county relies on sub-specialists to serve as primary-care physicians, academy doctors said.

This results in increased referrals by the specialists, who often are unable to handle as broad a spectrum of cases as family practitioners, the doctors said. In addition to the cost of each referral, specialist testing and treatment costs are generally higher than for the family practitioner.

Of the 5,700 physicians in San Diego County, about 1,100 are generalists, including family doctors, general internists and pediatricians, said Stephen Salisbury, senior vice president for physician relations at Sharp HealthCare group.

According to the lowest standard for adequate care set out by the California State Health Plan, San Diego County needs 1,000 family practitioners to effectively serve its population, said Joe Scherger, who is heading a new residency program for family doctors run by the Sharp medical group. The number of family practitioners in the county is about 600, Scherger said.

The term family doctor is often used interchangeably with the dated term general practitioner. Included with family physicians in the “generalist” category are internists, who typically treat adults, and pediatricians, who treat children. Family doctors are trained to treat everyone.

Since 1969, family doctors have been required to complete a three-year certified residency program, of which there are only 33 in California. San Diego has one program at UC San Diego Medical Center, which graduates six doctors each year.

A Sharp program is scheduled to begin in July, 1994, pending certification by the state. It is designed to graduate 12 doctors in the first class, and increase to 36 by 2000, Salisbury said.

Although the county’s deficiency stems from a nationwide dearth of family doctors, San Diego suffers additional difficulties attracting residents interested in the family practice because of the lack of training programs.

Certified family doctors also may be discouraged from coming to San Diego because of the emphasis on specialty medicine in the area. Slightly more than 10% of the county’s 5,700 physicians are family practitioners, academy doctors said.

Other factors serve to discourage doctors from going into family practice, foremost of which is lower income. Family practice is the lowest paying specialty, earning 69% of the annual median income for all physicians, according to the Academy of Family Practitioners.

The costs of setting up a general practice office are often higher, and family practices have more often been located in underserved or impoverished areas where the reimbursement rate is less than more affluent areas.

At the academy’s convention, the group’s governing body approved a strategy plan to develop cost-effective, family-based medical care and to improve access to medical services for the nation’s 38 million people who are uninsured and lack adequate care.